title: Contraceptive discontinuation and switching among couples receiving integrated HIV and family planning services in Lusaka, Zambia.
abstract: OBJECTIVE
  To describe predictors of contraceptive method discontinuation and switching behaviours among HIV-positive couples receiving couples' voluntary HIV counselling and testing services in Lusaka, Zambia.
  
  
  METHODS
  Couples were randomized in a factorial design to two-family planning educational intervention videos, received comprehensive family planning services and were assessed every 3 months for contraceptive initiation, discontinuation and switching.
  
  
  METHODS
  We modelled factors associated with contraceptive method upgrading and downgrading via multivariate Andersen-Gill models.
  
  
  RESULTS
  Most women continued the initial method selected after randomization. The highest rates of discontinuation/switching were observed for injectable contraceptive and intrauterine device users. Time to discontinuing the more effective contraceptive methods or downgrading to oral contraceptives or condoms was associated with the women's younger age, desire for more children within the next year, heavy menstrual bleeding, bleeding between periods and cystitis/dysuria. Health concerns among women about contraceptive implants and male partners not wanting more children were associated with upgrading from oral contraceptives or condoms. HIV status of the woman or the couple was not predictive of switching or stopping.
  
  
  CONCLUSIONS
  We found complicated patterns of contraceptive use. The predictors of contraception switching indicate that interventions targeted to younger couples that address common contraception-related misconceptions could improve effective family planning utilization. We recommend these findings be used to increase the uptake and continuation of contraception, especially long-acting reversible contraceptive (LARC) methods, and that fertility goal based, LARC-focused family planning be offered as an integral part of HIV prevention services.
authors.affiliation: aRwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine bDepartment of Gynecology and Obstetrics, Emory University, School of Medicine cDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA dDepartment of Gynecology and Obstetrics, School of Medicine, University of Zambia, Lusaka, Zambia eDepartment of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama fHubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA gMinistry of Community Development, Mother and Child Health, Lusaka, Zambia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Haddad
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Wall
authors.forename: Bellington
authors.initials: B
authors.lastname: Vwalika
authors.forename: Naw Htee
authors.initials: NH
authors.lastname: Khu
authors.forename: Ilene
authors.initials: I
authors.lastname: Brill
authors.forename: William
authors.initials: W
authors.lastname: Kilembe
authors.forename: Rob
authors.initials: R
authors.lastname: Stephenson
authors.forename: Elwyn
authors.initials: E
authors.lastname: Chomba
authors.forename: Cheswa
authors.initials: C
authors.lastname: Vwalika
authors.forename: Amanda
authors.initials: A
authors.lastname: Tichacek
authors.forename: Susan
authors.initials: S
authors.lastname: Allen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001521:Behavior Therapy / Q000379:methods; D003267:Contraception / Q000379:methods* / Q000706:statistics & numerical data; D003270:Contraceptive Agents / Q000008:administration & dosage*; D019033:Delivery of Health Care, Integrated / Q000379:methods*; D005191:Family Characteristics; D005193:Family Planning Services / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000517:prevention & control; D006266:Health Education / Q000379:methods; D006302:Health Services Research; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D055815:Young Adult; D015024:Zambia
chemical_list: D003270:Contraceptive Agents